Japanese Journal of Allergology

Aim: In order to specifically quantify the two major Dermatophagoides spp. allergens, Der p 1 and Der f 1, separately, we tried to establish a highly sensitive enzyme-linked immunosorbentassay (ELISA). Methods: Ninety-six-well ELISA plates were coated with mouse monoclonal antibodies specific against Der p 1 or Der f 1. Allergen samples were incubated in the wells for 2 hours at 37℃. After washing with PBS-T, biotinylated rabbit anti-Der 1 polyclonal antibody was added to the wells. The allergens were detected using horse radish peroxidase-conjugated streptavidin, an enzyme substrate (TMB/H_2O_2) and a microplate reader. Results: The working range of both ELISA systems for Der p 1 and Der f 1 was 40-2500pg/ml. The intra- and inter-assay coefficients of variation for reproducibility were 0.99-4.38% and 0.68-3.02%, respectively, in Der p 1 ELISA and 1.54-3.65% and 0.39-4.77%, respectively, in Der f 1 ELISA. Moreover, these ELISA systems showed that there was no cross-reactivity between Der p 1 and Der f 1 allergens. Conclusion: These ELISA systems may be useful for measuring less than 1ng/ml of major mite allergens in house dust samples, various pharmaceutical studies such as evaluation of an allergen-inactivating agent, and standardizing recombinant/natural Dermatophagoides spp. allergens.

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Background and Methods: The objective of this study was to analyze the sensitization to casein and β-lactoglobulin (BLG) in children with cow's milk allergy (CMA) in Japan. To this end, 115 CMA children were selected on the basis of the presence of cow's milk-specific IgE antibodies in serum and compatible clinical history. Specific IgE antibodies against casein and BLG were determined using CAP-RAST (considered positive when score 2 or more). Results: Titer of anti-casein IgE was significantly higher than that of anti-BLG IgE in CMA patients. IgE antibodies specific to casein were positive in 107 patients (97.3%), while those to BLG were positive in 51 patients (46.6%). Forty-eight patients (43.6%) were positive to both casein and BLG. We divided patients to two groups who were sensitized to casein only (C group) and who were sensitized to both casein and BLG (C/B group). No significant difference was seen in sensitization rate to white egg between C/B group and C group. However titer of anti-white egg IgE was significantly higher in C/B group than C group. As for sensitization rate and levels of specific antibodies to mite and Japanese cedar pollen there was no difference between two groups. Rates of resolution of CMA at the 3 years of age were higher in the C group than C/B group. Conclusion: In conclusion we found that casein is a major allergen of cow's milk allergy in Japanese children. Patients who are sensitized to several milk allergens are likely to be more sensitized to other food allergens. Sensitization to several milk allergens tends to have poor prognosis of CMA.

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Background: Inhaled corticosteroid (ICS) therapy has been reported to improve relapses of asthma following emergency room (ER) discharge, but the benefits of ICS prescription at discharge from the ER are unclear. Objective: To assess background of the patients who visit ER, and determine whether the prescription of ICS at ER reduces relapses in the patients with asthma. Methods: A prospective multi-center cohort study was conducted at 32 Japanese ERs. Patients aged two to 82 years who visited ER with moderate to severe exacerbation of asthma underwent questionnaire and follow-up three and six months later. The primary observations were of the asthmarelated hospitalizations, ER visits, and unscheduled visits. Results: Among 343 asthma patients (Children: 120, Adults: 223), 33% of children and 12% of adult patients were classified as intermittent asthma, retrospectively. The patients with intermittent had the same rates of hospitalization (29.6%) and ER visits (46.2%) as those with persistent (hospitalization rate: 24.7%, ER visits: 53.1%, ns) before enrolled. The odds ratio for hospitalization in the patients received ICS at the discharge from the ER, compared with the patients who did not received ICS, yielded 0.256 (95% confidence interval, 0.069 to 0.942; p=0.040) by multinomial logistic regression model. Conclusion: Prescribing ICS at discharge from the ER to asthma patients is associated with the reduction of risk for asthma-related hospitalization. For patients discharged from the ER, including mild intermittent asthma, ICS might be prescribed.

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